Jessica Berry Henderson, PH.D., L.P.C

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4508 Issued in ID

Practice address

3852 N Eagle Rd
Boise, ID 83713-0750

Phone

(208) 378-0014

NPI assigned

Oct 1, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Counseling Center at Tree City, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boise, ID
  • NPI 1083246904
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1306197256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2351 S RIDGE POINT WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837128522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3852 N EAGLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130750",
            "telephone_number": "208-378-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JESSICA",
        "middle_name": "BERRY",
        "name_prefix": "Dr.",
        "credential": "PH.D., L.P.C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-01",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "4508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Hendershot, OTR/L
• Henderson Chiropractic PLLC
• Andrea J Henderson, PT
• Autumn Henderson, M. ED
• Jenna Kaitlyn Henderson, DPT
• Jessica D Henderson, LCSW
• Joan Marie Henderson, EDD
• Lindsay Henderson
• Marni Marie Henderson, B.S.
• Spencer Dean Henderson, D.C.

• Professional Counselor in Boise, ID
• Providers in Boise, ID by specialty
• Professional Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.